Developmental Surveillance and Screening Policy Implementation Project (D-PIP)
“Implementing Developmental Screening and Referrals: Lessons Learned From a National Project” was early released on January 25, 2010 via Pediatrics eFirst Pages. The study also appeared in the February 2010 print edition of Pediatrics. (Note that a subscription to Pediatrics is required to view the full article.)
In 2006, the AAP released a policy statement on developmental surveillance and screening, including an algorithm to aid practices in implementation. Simultaneously, the AAP launched a nine-month pilot project, the Developmental Surveillance and Screening Policy Implementation Project, in which 17 diverse pediatric practices sought to implement the policy statement’s recommendations. The project assessed the degree to which a national sample of practices could implement recommendations for developmental screening and referrals, and identified factors contributing to the successes and shortcomings of these efforts.
At the project’s conclusion, practices reported consistently screening more than 85% of patients at recommended ages. They achieved this by dividing responsibilities among staff and actively monitoring and measuring implementation. Challenges were identified in implementing a 30-month visit; administering a screen after surveillance suggested concern, and submitting simultaneous referrals both to medical subspecialists and local early intervention programs. Practices reported referring only 61% of children with failed screens. Many practices also struggled to track referrals.
Overall, the project uncovered that a diverse sample of practices successfully implemented developmental screening as recommended by the AAP practices, but were less successful in placing referrals and tracking those referrals. More attention needs to be paid to the referral process, and many practices may require separate implementation systems for screening and referrals.
The Developmental Surveillance and Screening Policy Implementation Project (D-PIP) selected 17 pilot primary care pediatric practices to implement the AAP policy statement, Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening to determine if the use of the policy, specifically, the algorithm, changes the delivery of developmental surveillance and screening. In particular, the project aims to determine if the algorithm is efficiently and effectively implemented into pediatric practice, recognize strategies for implementing the algorithm, and examine outcomes of implementing the algorithm. Following the project, information is being shared with pediatric clinicians and other health care professionals who are seeking to improve the delivery of developmental surveillance and screening.
- A copy of the algorithm can be downloaded by clicking here.
- To access an interactive version of the algorithm, click here.
This project examined the following questions:
- Can the algorithm be efficiently and effectively implemented into pediatric practice?
- What strategies are used by practices to successfully implement the algorithm (eg, office procedures, time accommodations, follow-up procedures)?
- What are the outcomes of implementing the algorithm?
17 practices were selected to participate in the D-PIP. Click here to view the list of practice teams who participated in the project.
Practice teams were responsible for:
- Identifying three practice team members, one of which had to be a pediatrician to serve as the team leader for this project (Note: completed)
- Choosing a well-defined method of data collection for the practice (eg, chart review, tally-method, administrative systems reporting/EMR, etc) and identifying a practice team member to lead the data collection efforts (Note: completed)
- Participating on a conference call to discuss baseline data collection and reporting (Note: completed)
- Collecting and reporting on baseline data for one month using a standard data reporting form (Note: completed)
- Completing a pre-implementation survey (Note: completed)
- Sending the entire practice team to a training/planning workshop (Note: completed)
- Preparing the practice for implementation for two weeks following the workshop (Note: completed)
- Implementing an algorithm using strategies determined by the practice team
- Collecting and reporting on data monthly for nine months following the training using a standard data reporting form
- Maintaining a list of children age 8-36 months who were referred for questions addressed in the post-implementation survey
- Completing a post-implementation survey
- Sharing data and reports with AAP project staff and principal investigator
- If owned by a health care institution, seeking Institutional Review Board approval for participation in the project
The overall design of the project included:
- A pre-implementation survey conducted upon practice selection
- A baseline assessment for one month
- A training/planning workshop / implementation resources
- A data collection period for nine months
- A post-implementation survey
- Qualitative Interviews
1. Pre-Implementation Survey
The pre-implementation survey was the method used to determine the practices’ understanding of developmental surveillance and screening, as well as their current procedures regarding developmental surveillance, screening, and referral.
2. Baseline Assessment
A baseline assessment was conducted for one month prior to a training workshop. Practices were required to report data using a standard reporting form that reflected the type of data each practice needed to collect. The method of data collection was the individual choice of the practice.
3. Training/Planning Workshop Photo
A training/planning workshop was conducted for the 17 practice teams in June 2006 to introduce them to the new policy recommendations and algorithm and help them develop a plan for implementation.
Learning objectives included:
- Establishing a clear understanding of the policy implementation project and practice responsibilities
- Demonstrating a working knowledge of the algorithm and policy statement
- Providing sample data collection methods and strategies and explain the data reporting tool instructions
- Developing skills in using appropriate CPT codes for developmental surveillance and screening (96110)
- Understanding confidentiality requirements of the project
- Identifying and outlining steps for implementing the policy statement and algorithm into their particular practice
- The Developmental Surveillance and Screening Policy Implementation Project; Paul Lipkin, MD, FAAP
- Office Systems Change; Paula Duncan, MD, FAAP
- Developmental Surveillance and Screening; Paul Lipkin, MD, FAAP
- Introduction to Policy Statement Algorithm; Nancy Swigonski, MD, MPH, FAAP
- Developmental Screening Tools; Michelle Macias, MD, FAAP
- Putting the Office Systems in Place/Overview of Data Collection; Paula Duncan, MD, FAAP
- Developmental Screening: Billing and Coding; Michelle Macias, MD, FAAP
- Sample appeals letter to insurers advocating separate payment for developmental screening
- Screening Implementation: Referral and Follow-up; Paul Lipkin, MD, FAAP
Resources to Help the Practice Change Process
Resources to Implement Practice Changes
A special thanks to our D-PIP workshop planning subcommittee and faculty:
- Paul Lipkin, MD, Council on Children with Disabilities, Principal Investigator
- Paula Duncan, MD, Bright Futures Steering Committee
- Michelle Macias, MD, Section on Developmental and Behavioral Pediatrics
- Nancy Swigonski, MD, MPH, National Center for Medical Home Implementation Project Advisory Committee
Monthly Data Collection
Practices collected data reflecting the algorithm for nine months.
Post Implementation Survey
A Post-Implementation Survey was be conducted to determine:
- If changes were made in the knowledge and delivery of developmental surveillance and screening as a result of the policy statement implementation
- Strategies used to implement the policy statement/algorithm
- Outcomes of implementation, benefits of the algorithm process, and barriers encountered
- Overall evaluation—based on this experience, will your practice continue to do this?
Recently, the Commonwealth Fund has funded and expansion of the D-PIP that will include qualitative interviews conducted by evaluators from Johns Hopkins University. They will conduct two rounds of telephone interviews asking three practice team members in each practice about such issues as families' response to screening implementation, the amount of staff effort, time and money required, helpful resources, and disruption to usual patient flow.
Click here to view questions and answers that various practice team members have had regarding developmental surveillance and screening, reimbursement, data collection, and more! This document will be continually updated.
The D-PIP is funded by a cooperative agreement between the AAP and the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention and a cooperative agreement between the AAP and the Maternal and Child Health Bureau.